Optimizing frontal sinus minitrephination: A computed tomography-based anatomical analysis for enhanced surgical precision

Aim: Surgical management of chronic frontal sinusitis poses significant challenges due to the highly variable anatomy of the frontal sinus. While endoscopic sinus surgery (ESS) is commonly employed, it has limitations in accurately diagnosing and excising frontal sinus pathology, particularly in visualizing drainage pathways. Minitrephination serves as a less invasive alternative; however, anatomical variation often complicates the identification of a reliable entry point. This study aims to determine optimal anatomical landmarks for frontal sinus minitrephination using three-dimensional computed tomography (CT) imaging, with the goal of improving surgical accuracy and safety. Methods: A total of 432 patients (864 frontal sinuses) were evaluated using 64-slice multidetector CT (MDCT) scanning. Frontal sinus dimensions and maximum depth were measured relative to predefined X and Y axes on axial, coronal, and sagittal images. Anatomical variations, including hypoplasia, were also recorded. Results: Hypoplastic frontal sinuses were identified in 4.4% of right and 3.5% of left sinuses. The average depth of the frontal sinus was 14.43 ± 4.73 mm on the right and 14.48 ± 5.43 mm on the left. No significant correlation was found between sinus measurements and patient age. However, male patients exhibited significantly greater Y-coordinate values and frontal sinus depth compared to female patients (p < 0.05). Conclusion: This study quantitatively demonstrates the extent of anatomical variation in the frontal sinus region and highlights sex-related differences. The findings support the implementation of precise CT-based preoperative planning for frontal sinus minitrephination. Such individualized anatomical mapping may reduce procedural complications and improve surgical outcomes in patients undergoing treatment for chronic frontal sinusitis.